Healthcare Provider Details

I. General information

NPI: 1114970548
Provider Name (Legal Business Name): JOSEPH P MULLEN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E GROVER ST
SHELBY NC
28150-3917
US

IV. Provider business mailing address

406 JOHNSFIELD RD
SHELBY NC
28150-6174
US

V. Phone/Fax

Practice location:
  • Phone: 704-480-1087
  • Fax: 704-480-1150
Mailing address:
  • Phone: 704-480-7678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number009300769
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9300769
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: